Category: General Information

Archive for the ‘General Information’ Category

Feb 24 2016

About This Blog

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This blog is serving as the site for our class, Elon University’s DPT 801: “Management of the Pediatric Client 2015 & 2016″. We intend to post accumulated knowledge of a collection of tests & measures utilized in the practice of physical therapy with a pediatric client. All work on this site is student generated and references are noted.  This site is a work in progress that ultimately will be a resource; to review the purpose and function of the various test & measures available to acquire data in the gross motor examination of children.


To read about a particular test/measure, find the name of the instrument in the “T&M Tools” drop-down list at the upper left of this page and click on it. To return to this home page, click on the “Home” text in the navigation bar at the top of any page.

Mar 06 2016

Test of Infant Motor Performance (TIMP)

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Barbosa VM, Campbell SK, Smith E, Berbaum M. Comparison of Test of Infant Motor Performance (TIMP) item responses among children with cerebral palsy, developmental delay, and typical development. Am J Occup Ther. 2005;59:446-56.

The purpose of the above study was to analyze collected data from an individual Infant Motor Performance test (TIMP) in a sample of infants to determine which individual items were the best indicators for cerebral palsy. The TIMP has 28 observed items such as head centering and individual finger movements, while 31 items examine motor responses in various positions & visual/auditory stimulation. Each infant was assessed using the TIMP repeatedly from birth to approximately 4 months corrected age. Follow-up information was later collected after the study to see if any of the infants were diagnosed with Cerebral palsy at 1 to 11/2 years of age.

The study originally included 96 infants that were born from 1996-1998 that were at risk for poor developmental outcomes in Chicago. Once the study was complete, the 96 infants were then put into one of three groups at the 1.5 year old mark as: 1) typically developing (TD) 2) motor delayed (MD) and 3) having cerebral palsy (CP). The diagnosis was made based on a pediatrician’s clinical judgment and independent assessment of AIMS at 12 months of age for each infant. Scores below the 16th percentile rank on AIMS without diagnosis of CP was used to define DD. Since 11 infants were unavailable for a follow-up diagnosis, there were excluded from the study. During the study, eleven testers participated in the weekly TIMP assessment of the infants.

To analyze the data, a graphical and Rasch analysis were used. In the graphical exploratory analysis, the CP group compared to the TD and MD group had a better performance than average in items involving neck extension (E23) and lateral head righting in vertical suspension (E30/31). However, staring at 2 weeks post term, children with CP showed decreased ability to hold head in line with midline (E9) of the body in supine and continued to remain delayed compared to typical developing and those with delays and without CP despite improvements. Arm movements against gravity were also poor in the CP from 2-10 weeks (E14), but only reached average performance level of delayed infants at 12 weeks. The CP group also were less likely to inhibit trunk rotation to the side when head is passively rotated (E7/8), have poor anterior-posterior head control (E4/5) in supported sitting, and lateral hip abduction reactions (E22) and unable to mature. The CP group showed signs of difficulty at the 90-day mark with postural control compared to the TD and DD. The CP group also regressed in developmental skills such as antigravity hip flexion and kicking during the study, which was not present in the TD and DD groups.

The Rasch Analysis grouped infants by age of each development group and compared line items. The Rasch analysis showed the CP group having overall difficulty of 11 observed and 19 elicited items. Some key items include: head in midline, hand to mouth & trunk control in supported sitting. TD children compared to CP group had difficulty with head turning to the side in prone/supine, turning to sound in prone and arm movement in prone. Overall, the Rasch analysis identified the same 17 of the 30 items the CP group behaved differently in compared to the TD group in the graphical analysis group. The WINSTEPS statistical program used to analyze the DIF data.

Overall the study revealed that the TIMP did well in quantifying improvements in movement patters but there is still no proof of neurological impairments presenting the same at every age. However, most early atypical motor behaviors of children with CP presented the most at 90 days of age. One item of the TIMP that was highly significant in determining children with CP compared to DD without CP was decreased neck flexion when pulled to sit at 90 days. CP group also had consistent difficulty with movements against gravity compared to the other groups and supported other literature for preterm infants and infants who were later diagnosed with CP.

Mar 07 2016

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)

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Source: Pearson P.O. Box 599700 San Antonio, TX 78259

Cost:  Web-based administration, scoring and reporting

BOT-2 Q-global Complete Form Report: $2.00

BOT-2 Q-global Short Form Report: $1.00

Unlimited-Use Scoring Subscriptions

BOT-2 Scoring 1-year subscription: $35.00

BOT-2 Scoring 3-year subscription: $99.00

BOT-2 Scoring 5-year subscription: $149.00

Manual scoring

BOT-2 Complete Form Test Kit: $879.40

BOT-2 Fine Motor Kit: $541.10

BOT-2 Gross Motor Kit: $541.10

Reference:  Accessed March 5, 2016.


Cho et al. conducted a study that assessed motor proficiency in children with attention-deficit hyperactivity disorder (ADHD) and had a control group to determine if children in Korea with ADHD have motor deficits.  They recruited 58 children with ADHD with mean age of 9 years 6 months ± 2 years and 70 controls with mean age of 9 years 2 months ± 1 year 7 months.  The children with ADHD were diagnosed by two psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). The psychiatrist also administered the Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version to determine if the children had any comorbidities.  The authors used the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) to assess motor proficiency.  The children with ADHD had significantly lower mean standard scores in all 4 composite scores: fine manual control, manual coordination, body coordination, and strength and agility, and total motor composite score.  There were also no significant differences in age between the two groups, indicating children with motor deficits will continue to have deficits as they grow older and early therapeutic interventions are required.  Additionally treatment of motor problems could improve children’s self-esteem, learning, physical activity and overall development.

Cho H, Ji S, Chung S, Kim M, Joung Y. Motor Function in School-Aged Children with Attention-Deficit/Hyperactivity Disorder in Korea. Psychiatry Investigation. 2014;11:223-227.

Feb 24 2017

Pediatric Quality of Life Inventory (PedsQL)

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The Pediatric Quality of Life Inventory (PedsQL) is a useful tool to evaluate the reported quality of life in children within a healthcare setting as per the child’s self-report or the parent/caregiver’s observations. The preliminary post addresses many details about this inventory measure, however, there are some additional facts to be mentioned.

In addition to this inventory having usefulness in healthcare settings, the tool was designed for employment in community and school populations. Due to the nature of this design, the inventory contains segments that address the physical, emotional, social, and scholastic functioning of the child, in question. These segments are broken into two categories of scores, the physical health summary score and the psychosocial health summary score. Together, these scores give a more well-rounded and complete depiction of the child’s status. Even more useful about this tool, is that there are disease-specific modules of the measure that are available to tend to the unique circumstances of a particular child. Further, since the tool can be administered at different points in the child’s experience, it is known to be a responsive measure of change. Despite the efficacy of such a tool, it is fully protected under copyright, with all rights reserved to Dr. James W. Varni; thus the mention of cost variances in the preceding post.

Since the inception of this measurement tool, there have been a number of studies performed to validate the reliability and validity of the inventory. One such article is that by authors, Desai et al. This publication’s purpose is to assess the validity of the Pediatric Quality of Life Inventory (PedsQL) in the pediatric hospital inpatient setting. The authors provided the PedsQL to children between the ages of 1 month and 18 years old who were admitted to Seattle Children’s Hospital between October 1, 2011 and December 31, 2013. The exclusionary factors implemented precluded the following patients and their families from participating: those who are younger than 1 month old, those who require protective isolation, those who were asked to participate within 2 months prior to this study, those who require 24-hour video EEG or pH probe studies, those of suspected child abuse, or those with developmental delays. Approximately 38% of qualified participants completed the surveys from the time of admission as well as upon discharge. The responses to the inventory were either reported by the parents or caregivers, or the child, him/herself.

Methods: Those who participated received the inventory within 72 hours of admission to the hospital as well as 2-8 weeks after discharge from the hospital. Overall, the PedsQL assesses 4 domains of a child’s experience with his/her quality of life: physical functioning, emotional functioning, social functioning, and school functioning. The inventory can be designed either for the child to assess him/herself or for the parent/caregiver to act byproxy. However, there is also the PedsQL Infant Scale, for those between the ages of 1-24 months, that assesses 5 domains of the child and is filled out by a parent/caregiver. These domains are as follows: physical functioning, physical symptoms, emotional functioning, social functioning, and cognitive functioning. The scale score responses were converted into numbers ranging from 0 to 100 and were statistically analyzed. A higher score means a better quality of life. The PedsQL Inventory is the actual outcome measure being assessed in this study, rather than any intervention. The purpose of the authors’ work is to assess the validity and efficacy of the PedsQL as an outcome measure, rather than assess an intervention applied. The participants in the study received the interventions that were suited for their individual diagnoses and needs, as per the hospital’s standards. The PedsQL was administered to gauge the quality of life of each participant and assess whether the scores followed the theoretical trends, making the inventory a useful tool for measuring children’s experience while they are inpatients in a hospital. The scores were analyzed via the calculations of improvement from admission to discharge follow up. The data was applied towards a paired t-test and Cohen d analysis to identify the significance in the score changes.

Results: The findings from the study indicate that the PedsQL has the ability to accurately assess the quality of life of children in the inpatient setting. The results showed that those with more complex conditions and/or chronic illnesses, held a decreased quality of life as compared to those without chronic conditions. The results of the inventory also showed that the scores improved between the time of admission and discharge, as predicted. These results indicate that the PedsQL does have the ability to demonstrate the QOL as reported by patients and their caregivers, that is in keeping with the expected norms and trends.

The strengths of this study are that it is the first of its kind to fill a gap in the known data regarding the PedsQL. It is the first study to evaluate quality of life in a large and diverse population of children within a hospital setting. The participants included in the study are from various backgrounds, diagnoses, and ages. This study found that the PedsQL has the strength to be integrated into the protocol of patient case-load to assess and track patient experience. Due to the authors’ comparison of the calculated results to expected norms, this study is also the first to identify the predictive properties of the PedsQL in a hospital setting. Another strength is that the inventory has the ability to act as a subjective and objective outcome measure. Additionally, the authors were able to run statistical data analysis, which adds to the validity of their findings.

As with any study, there are limitations. In this particular instance, the downfalls include the following: caregiver reports may not be as reliable as patient report in terms of psychological health, the study was conducted at one hospital and may be considered lacking in true heterogeneity, there was a very limited response after discharge that has the potential to contribute to bias, and the authors allowed for an exaggerated timeframe for families and patients to submit their discharge surveys, which may have produced responses with added variables that affected the follow up scores.

Conclusion: The PedsQL has the ability to evaluate and record the quality of life of juvenile patients in hospitals through either patient report or by parent/caregiver report. This inventory is a simple way to assess the status of patients as well as to administer within hospital settings. With the implementation of the PedsQL in hospitals, there can begin to be a valid and reliable method of determining how effective interventions are and how appropriate patient care and management are. Further, the inventory may be used as a predictive tool to determine length of stay, rehab potential, and potential re-admission risk.




Desai, A. D., Zhou, C., Stanford, S., Haaland, W., Varni, J. W., & Mangione-Smith, R. M. (2014). Validity and Responsiveness of the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales in the Pediatric Inpatient Setting. JAMA Pediatrics, 168(12), 1114-1121. doi:10.1001/jamapediatrics.2014.1600

Varni, J. W. (1998). PedsQL TM (Pediatric Quality of Life Inventory TM). Retrieved February 22, 2017, from

Feb 25 2017

School Function Assessment (SFA)

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  1. SFA complete kit $243.50
  2. SFA user manual $151.50
  3. SFA record forms $102.50
  4. SFA rating scale guides $25.00


  1. The SFA helps students in elementary schools succeed by identifying their strengths and needs in important nonacademic functional tasks.
  2. It can also be used to develop an IEP, facilitating collaborative planning, documenting progress and effects of intervention, collecting administrative data to meet federal and state regulations

MCID: not established


Article Summary:

Outcomes for Students Receiving School-Based Physical Therapy as Measured by the School Function Assessment [Internet]. PubMed Journals. Available from:

The purpose of this article was to describe School Function Assessment (SFA) outcomes in students, after receiving 6 months of school based physical therapy, and the effects of age and gross motor function on outcomes. It took place in 28 states, and was conducted by 109 physical therapists on 296 students with disabilities, aged 5-12. The most common diagnoses for the students were cerebral palsy and Down Syndrome. PT’s administered the SFA to students at the beginning of the school year, and at the end of 6 months. In conclusion, most students made positive gains within the scales of the SFA across 6 months of receiving school based PT. Those who showed signs of regression were due to an onset of new medical problems. Overall, students made the most gains in the scales of participation, maintaining and changing position, task supports: adaptations, and manipulation with movement. These scales were followed by travel and recreational movement. The students showed less improvement on the ADL scale, an area most likely not addressed by the PT’s. Those students who were older and had lower scores on the GMFCS demonstrated fewer improvements on the SFA.

Major strengths of this study include a large sample size (n), and high internal consistency of the SFA. Limitations of this study include the use of the GMFCS for students with other diagnoses besides cerebral palsy, no control of intervening factors such as amount/frequency/duration of services, and the large amount of PT’s who completed the SFA assessments.

Feb 26 2017

Canadian Occupational Performance Measure (COMP)

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As of February 2017, the COMP review remains largely unchanged from the original blog post on March 16, 2015.  The MCID for the COMP remains not established.  Listed below are a few additions to the original list.

  • Equipment and Materials Needed
    • A paper form can be used or an App can be used on electric devices
  • Psychometric Characteristics
    • Not well established

With regard to the overall summation of the COMP (in addition to the original post)

Summary Components:

  • Strengths
    • Used in 40 countries and translated to 35 different languages
    • Takes into consideration and utilizes patients important perceived problems
    • Client centered practice
    • Focuses on occupational performance as well as leisure, self-care, and productivity
    • Longevity in use (originally published in 1991)
  •  Weaknesses
    • Designed for the use of Occupational Therapists
    • Data is specific to the paitent, making it a harder test to generalize
    • Legitimacy of the patients viewpoints



Article Summary:

Functional outcomes of intramuscular botulinum toxin type A and Occupational Therapy in the upper limbs of children with Cerebral Palsy: a randomized controlled trial. Physical Medicine and Rehabilitation Journal. Available from:

The purpose of this article was to investigate the functional outcomes of using Botulinum Toxin Type A injections to the upper limbs in conjunction with Occupational Therapy in children diagnosed with Cerebral Palsy.  The study utilized a randomized controlled trial design and obtained baseline measures with follow up at 2 weeks, 3 months, and 6 months.  The study included 80 children diagnosed with spastic quadriplegic, triplegic, or hemiplegic CP and were randomly assigned into 4 different groups: a Botulinum Type A Injection with OT group, Botulinum Type A injection only group, OT only group, and a no treatment control group.  Intervention consisted of a single set of Botulinum Toxin Type A injections and 12 weeks of OT if allocated to those groups.  Furthermore, the participants were only eligible if they were between the ages of 2-14 with a mean age of 5 years and 11 months +/- 3 years, had a Modified Ashworth Scale score of 2 or 3 in at least one of their UE’s, and goals of the patient/family were related to improving some form of UE function.  The study used the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS) as their primary outcome measures.  OT invention began 1 week after baseline assessments and children in one of the OT groups received 1 hour a week of therapy for 12 weeks.  The therapy components of the intervention were not standardized, but determined by the treating clinicians to ensure the intervention was appropriate for the participants to meet their goals.  Intervention did include the following: stretching, casting splitting, and attempts to enhance activity by motor training, environmental modification, and practice of specific goals.  The results of the study found that the combination of the Botulinum Toxin Type A injection and OT resulted in an increased attainment of the goals set by the patient, measured using both the GAS and the COPM.  Interestingly, other secondary outcome measures and performance measures that were looked at including the quality of UE skills tests, the Pediatric Evaluation of Disability Inventory, the Melbourne Assessment of Unilateral Upper Limb Function, active and passive ROM showed no differences between the groups.  With regard to muscle tone, there was a significant reduction 2 weeks after injection, but returned to baseline levels by the 6 month follow up.  In conclusion, it was shown that OT enhanced individualized functional outcomes following Botulinum Toxin Type A injections in the upper limbs of children with CP, based off of their functional goals.  It also enhanced the self-reported, individualized outcome measures of both the COMP and the GAS in children with CP.

Strengths of the article: I think a strength of this article was the large sample size with relatively equal representation amongst the 4 different groups examined.  Also, I think the baseline assessment as well as assessment at 2 weeks, 3 months, and 6 months gave a good representation of the effect of treatment, injection, the combination, or the control.

Limitations of the article: One of the biggest limitations to me was the variability in therapeutic rehabilitation treatment.  Treatment was non-uniform amongst patients and was based off of their own goals and presentation.  This lack of uniformity could had increased the potential for error without a set, specific exercise protocol.  I think overall more control devoted to the actual rehabilitation protocol would have increased the strength of comparison, both with the OT only group and the OT and Botulinum Toxin Type A injection group.

Feb 27 2017

The Pediatric Stroke Outcome Measure: A Validation and Reliability Study

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Introduction/Background: The Pediatric Stroke Outcome Measure (PSOM) is appropriate for newborn to adult age for determining stroke-specific outcomes through 115 test items in 5 functional and neurological deficit subscales including: right sensorimotor, left sensorimotor, language production, language comprehension and cognitive/behavior. The PSOM is chronologically organized across the development spectrum. For instance, primitive reflexes are included for children <2 years. Scores for each item range from 0 (no deficit) to 10 (maximum deficit), and are summed to infer the total score. Administration time for this measure is approximately 20 minutes.

 Purpose: The purpose of this study was to examine the PSOM’s construct validity in measuring neurological outcomes in pediatric stroke survivors and interrater reliability for both prospective and retrospective scoring. When using this objective measure in a prospective study, one would evaluate a like group of individuals to determine how differing factors affect rates of certain outcomes. Whereas a retrospective study would compare those with a specific impairment following pediatric stroke to those who’ve not been exposed. The study verified the PSOM is valid and reliable for pediatric stroke in both types of studies, but is especially useful in scoring prospective clinical trials.

 Methods: Children, newborn to 18 years, diagnosed with arterial ischemic stroke (AIS) or cerebral sinovenous thrombosis (CSVT), at the Hospital for Sick Children (Toronto, CA), from 1994 to 2010 were included in this study. 203 Participants were serially examined with PSOM at 3, 6 and 12 months poststroke and at 2-5 year intervals until the age of 18. QoL and standardized neuropsychological outcomes were assessed in addition to the PSOM. Construct validity (for prospective study) was evaluated against the standardized neurophysiological measures and statistically analyzed through Spearman correlation, linear regression (95% CI), and an alternative chance-corrected statistical test. PSOM scores from medical records were scored by 3 raters and compared with “live” in-clinic PSOM exams completed by those same raters. This information was statistically analyzed to determine both retrospective validity and inter-rater reliability. The range for inter-rater agreement ranged from 0.0-0.2= poor to >0.8= almost perfect.

 Results/Limitations/Conclusion: The results indicate PSOM is both valid and reliable for use in children poststroke. These findings are relevant because the PSOM is the only measure of neurological outcomes for this population and is currently being or has been used in many research studies. Construct validity proved to highlight relevant impairments in all 5 subcategories including significant correlation between the cognitive-behavioral subscale and standardized neuropsychological measures of overall intellect, verbal/perceptual reasoning and parental/behavior questionnaires. Additionally, both in-clinic and health record-based scoring was found to have excellent reliability. Some limitations of this study were not all children consented to neuropsychological testing and normally distributed statistics potentially downplayed concerns regarding referral bias. Another shortcoming is that the PSOM is likely to be biased toward motor and sensory deficits over cognitive, language and behavioral impairments. Despite these limitations, the PSOM has proven to be a strong outcome measure, both valid and reliable for prospective and retrospective studies geared towards improving pediatric poststroke outcomes.


Kitchen L, Westmacott R, Friefeld S, et al. The Pediatric Stroke Outcome Measure. Stroke. 2012;43(6):1602-1608.

Feb 27 2017

Modified TUG for Preschoolers

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Descriptive Information 

Title, Edition, Dates of Publication and Revision: A Modified Version of the Timed Up and Go Test for Children Who are Preschoolers, 2016, modified from Williams et al. TUG-IC, 2005.

Authors: Evi Verbecque, PT; Luc Vereeck, PT, PhD; An Boudewyns, MD, PhD; Paul Van de Heyning, MD, PhD; Ann Hallemans, PhD

Source: Pediatric Physical Therapy Volume 28(4) Evi Verbecque, PT Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein 1, Antwerp 2610, Belgium. Email: evi.verbecque@uantwerpen,be

Costs (booklets, forms, kit): free, see below for equipment needed

Purpose: The purpose of this study was to investigate if the modified TUG is influenced by practice, if there is a difference in scores among age groups, and which factors are most predictive of TUG scores.

Type of Test: Screening for balance deficit indicative of further assessment and an evaluative measure.

Target Population and Ages: 172 preschoolers, age 3-5 without developmental disorders in Belgium were included in the study

Time Requirements – Approximately 5 min


Test Administration

Administration: The TUG for preschoolers is administered slightly different from the standard TUG with the placement of 2 chairs (seat height 27cm) placed 3.38m apart facing each other (the extra distance is to account for the reaching component to assure they walk the 3 meters). A Duplo brick is place on the second chair. The child begins seated in the first chair and is given the cue to start by counting 1,2, 3 “start”. The child begins walking as fast and safe as possible towards the second chair. The child is to grab the Duplo brick off the chair and walk back to the first chair and sit down. Timing starts when the cue is given to “start” and ends when the spine of the child touches the back of the chair.

Scoring: This study used the best of 3 trials, however in their discussion they mentioned performing trials until a plateau is reached to eliminate the practice effect.

Type of information, resulting from testing The mean score for 3-5 year olds was 7.11 seconds. This study determined age-specific reference values (mean score): 3 years old: 7.86 seconds, 4 years old: 7.3 seconds, 5 years old: 6.41 seconds.

Cut off values for those likely to have a balance deficit are: 9.92 seconds for 3 year olds, 9.84 seconds for 4 year olds, 8.61 seconds for 5 year olds.

Cut off for those at risk for balance deficit: are 8.89 seconds for 3 year olds, 8.57 seconds for 4 year olds, 7.51 seconds for 5 year olds.

Environment for Testing: Indoors on flat surface, hallway of school was used in this study 

Equipment and Materials Needed: 2 chairs with backrests and no armrests (seat height of 27cm), red Duplo Brick, measuring tape, and stop watch

Examiner Qualifications: none


Summary Comments

Strengths: This modified version of TUG is timely, easy, and inexpensive test. The forward reach integrates an extra challenge to the balance system. The modifications made in this study to the previous TUG-IC decrease the influence of the push off against the wall when performing the task.

Weaknesses: Practice effect may occur therefore it may be imperative to complete trials until plateau is reached. Children with upper limb dysfunction may show poorer results due to the added task of grasping and picking up the block. The researchers studied the correlation of age and ethnicity to scores, however I believe it would be beneficial to also study the height/leg length correlation to scores. There is a lack of inter-rater and test-retest reliability, sensitivity, and specificity therefore further research is required.

Clinical Applications: The Modified TUG can be used to evaluate and reassess functional mobility and dynamic balance in preschoolers. It can also be used as a screening mechanism compared to norms in order to determine if further assessment is required such as motor assessment or vestibular function testing.

Verbecque, E., Vereeck, L., Boudewyns, A., Van de Heyning, P., & Hallemans, A. (2016). A Modified Version of the Timed Up and Go Test for Children Who Are Preschoolers. Pediatric Physical Therapy28(4), 409-415.

Feb 27 2017

Craig Hospital Inventory of Environmental Factors (CHIEF)

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*Minimal updates were made to the original blog post in regards to the CHIEF. No updated or current research utilizing the CHIEF in pediatric PT was found as well.


(Accessed 20 February 2017)

Critical Review – CHIEF

By: Mariah Cole

Descriptive Information:

  • Title: Craig Hospital Inventory of Environmental Factors (CHIEF)
    1. Version 3.0 April 2001
    2. Published in 1999
    3. Updated and revised in 2012
  • Source:

Craig Hospital Research Department

3425 S. Clarkson Street, Englewood Colorado 80110

  • Costs: Free and easily accessible – manual and assessment available on Craig Hospital Website
  • Purpose: “To assess the degree of which elements of the physical, social, and political environments act as barriers or facilitators to full participation for people with disabilities.” Five domains assessed to evaluate environmental factors – accessibility, accommodations, resource availability, social support, equality.
  • Type of Test: Patient Reported Outcomes
  • Target Population and Ages:
    • Stroke, CP, SCI, TBI, MS, and Amputee
    • Adolescent (13-17), Adult (18-64), Elderly (+65)
  • Time Requirements – Administration and Scoring: 6 to 30 min
    • CHIEF – 10 min
    • CHIEF (short form) – 5 min
    • Add 5 min if administered by interview
    • Normally completed by individual

Test Administration:

  • Administration:Paper/pencil completion of 25 items by the individual (12 items for CHIEF–SF)
  • Scoring:
    • Frequency score (0=never, 1=less than monthly, 2=monthly, 3=weekly, and 4=daily) indicating frequency of encountering environmental barriers.
    • Magnitude scores (0=no problem, 1=little problem, and 2=big problem) indicating size of the problem barrier presented.
    • Frequency-magnitude product score (0-8) indicating overall impact of environmental barrier on individual’s life.
    • Scores are calculated by multiplying 25 items by the frequency, magnitude, and overall impact scores.
  • Type of Information, resulting form testing: Overall impact of environmental barriers on individuals’ ADLs, participation, and QOL
  • Environment for Testing: No specific requirements
  • Equipment and Materials Needed: None
  • Examiner Qualifications: None – no training required
  • Standardized/Normative data:
    • Community Dwelling Elderly Adults with and without Stroke
    • Chronic and Acute SCI
    • Children and Youth with Physical Disabilities
  • Evidence of Reliability:
    • Test-retest
      • SCI – excellent reliability total CHIEF (ICC=0.93)
      • SCI and TBI – excellent CHIEF total score (ICC > 0.90) and excellent sub-scale reliability (0.77 to 0.89)
      • Multiple Diagnosis (SCI, TBI, MS, Amputees, CP, Auditory/Visual impairments, Developmental Disabilities) – adequate reliability (ICC=0.62)
    • Interrater/Intrarater
      • SCI – adequate (ICC=0.62)
  • Evidence of Validity:
    • Content – SCI, TBI, amputee, MS, etc.
      • Content validity was demonstrated through the consensus of 4 Subject Matter Experts (SME’s) charged. The SME panel created 4 instruments that largely overlapped with each other. These instruments were then synthesized into a single measure (Whiteneck et al, 2004)
      • All CHIEF items, all subscales, and the total score produced statistically significant differences across the impairment groups (Whiteneck et al, 2004)
      • People with disabilities consistently reported an overall higher level of environmental barriers on all subscales and total CHIEF score than those without disabilities (Whiteneck et al, 2004)
      • People with severe disabilities generally scored higher on subscales and the total score than the full range of people reporting any disability (Whiteneck et al, 2004)
  • MCID: Not established

Summary Comments:

  1. Strengths:
    • The CHIEF is short, free, and easily administered with no requirements or equipment. A shorter version provided as well – CHIEF-SF.
    • Assesses factors that limit patients’ participation beyond physical impairments with hopes of removing the barriers to improve patient rehabilitation, recovery, and reintegration back into their lives.
    • Assesses domains such as physical accessibility, accommodations and modifications, resource availability, social support, and equality of opportunity and how elements of the environment can limit/impede or facilitate a patient’s participation, satisfaction, and QOL.
  2. Weaknesses:
    • No MCID or MDC
    • No standard error of measurement
  3. Clinical applications: As a physical therapist, it is important to identify, acknowledge, and understand the possible factors or elements that impede or assist in a patient’s rehabilitative process. It is our responsibility to advocate for our patients and educate them to provide the best potential for a successful outcome and improved quality of life.


Feb 27 2017

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)

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Source: Pearson P.O. Box 599700 San Antonio, TX 78259

Manual Scoring:

BOT-2 Complete Form Test Kit: $898.00

Reference: Accessed February 27, 2017.


Lin et al. researched the effects of touchscreen use on fine motor development in preschoolers. 80 children (N=80; boys: 52; mean age 61.0 ± 7.6 months) without developmental delay were split into two groups of 40 based on prior usage of touch screen tablets. The children who used a touchscreen for more than 10 minutes a day for a month were placed in the test group, and the others were in the non touch screen group. Researchers utilized the BOT-2 to examine each child’s fine motor performance before and after the study, and they also assessed pinch strength using a hand held pinch dynamometer before and after the study. Both groups participated in 20 minutes of training activities per day for 24 consecutive weeks. The test group completed their activities on an iPad for 20 minutes while the non touch screen group completed age appropriate activities (play dough, using scissors, drawing, etc.) for 20 minutes. After completing the training and the BOT-2 again, results showed that the non-touch screen group had significantly higher scores in fine motor precision, fine motor integration, and manual dexterity. There were n significant differences in pinch strength. A strength of this article is that they were able to get 80 children to participate in the study and they also did not have any children drop out. They also used two very reliable measures, the hand held dynamometry for pinch grip and the BOT-2. A limitation of this study is that they did not examine other factors that could affect the use of touch screens on fine motor development such as cognitive and visual skills. Although the y were able to complete this study on 80 children, they were not a good representation of all socioeconomic classes so the results may not be able to be applied to the general population. This research shows us the importance of not relying too much on the new technology of today because sometimes, as it is in this case, it is best for kids to play with crafts, even if its just for 20 minutes. This can also help to improve a child’s creativity and social skills.


Lin L-Y, Cherng R-J, Chen Y-J. Effect of Touch Screen Tablet Use on Fine Motor Development of Young Children. Physical & Occupational Therapy In Pediatrics. 2017;0(0):1-11. doi:10.1080/01942638.2016.1255290.